Provider Demographics
NPI:1669063327
Name:COLEMAN, LOUTRINA EVON (CNA)
Entity type:Individual
Prefix:MS
First Name:LOUTRINA
Middle Name:EVON
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 FLORA ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:GA
Mailing Address - Zip Code:30445-2756
Mailing Address - Country:US
Mailing Address - Phone:912-246-0883
Mailing Address - Fax:
Practice Address - Street 1:1139 FLORA ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:GA
Practice Address - Zip Code:30445-2756
Practice Address - Country:US
Practice Address - Phone:912-246-0883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0028892899374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide